Temporary Insurance Follow-up Specialist

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Pay range: $22.30 - $30.11 per hour, based on experience. This temporary position is expected to last for 6 months and is not eligible for benefits. In addition, this role is eligible to work remotely from an approved state by St. Charles (please refer to the list). If you do not reside in an approved listed state (or do not plan to relocate to an approved listed state) we request, you do not apply for this particular position. Approved states by St. Charles: Oregon, Arizona, Arkansas, Florida, Idaho, Missouri, Montana, Nevada, New Mexico, North Carolina, Oklahoma, Tennessee, Utah, and Wisconsin. ST. CHARLES HEALTH SYSTEM JOB DESCRIPTION _________________________________________________________________________________________________ TITLE: Insurance Follow-up and Denials Specialist 1 REPORTS TO POSITION: Claims Supervisor DEPARTMENT: Single Billing Office (SBO) DATE LAST REVIEWED: August 2024 OUR VISION: Creating America's healthiest community, together OUR MISSION: In the spirit of love and compassion, better health, better care, better value OUR VALUES: Accountability, Caring and Teamwork _________________________________________________________________________________________________ DEPARTMENTAL SUMMARY: The Single Billing Office (SBO) at St. Charles Health System (SCHS) provides revenue cycle services to our multi-hospital and medical group organization focusing on billing, collecting, and posting revenue. The goal of the SBO is to deliver a delightful, transparent, and seamless experience to patients and customers that captures and collects the revenue earned by SCHS in a quality, efficient and timely manner. Services include but are not limited to: billing insurance claims, posting insurance and patient payments, resolving insurance denials, collecting unpaid insurance claims, maintaining payer contracts in the EMR, resolving under and over payments, identifying and resolving payer issues, processing refunds, processing financial assistance applications, billing patients, resolving patient accounts including patient questions, and vendor management: lockbox, clearinghouse, early out, collection agencies. POSITION OVERVIEW: The Insurance Follow-up and Denials Specialist 1 position works simple to intermediate payer denials that require an entry level understanding of payer reimbursement methodologies, billing guidelines, and coding requirements. This position works with internal and external stakeholders including community providers, payer representatives, other SBO teams, and other St. Charles departments to resolve denials. This position does not directly supervise caregivers. ESSENTIAL DUTIES AND FUNCTIONS: Able to work all payers in a single financial class. Work may be sub-divided by dollar amount or denial type. Identify and resolve denials through research, appeal, correcting and rebilling claims, correcting coverage, submitting records, and escalating to payer and/or leadership. Apply root case net adjustments when all collection options are exhausted. Verify and update insurance coverage as applicable using EHR tools, payer websites, or via phone calls to payers. Apply entry to intermediate level research methodologies consistent with SBO department complexity matrix. Denials include but are not limited to (see matrix for complete list): Assistant surgeons Authorizations Benefit Maximum Simple billing requirements errors Bundled services (OP only) Simple charging related denials CLIA Simple coding related errors Coordination of Benefits Credentialing Duplicate denials, Inpatient Only Procedures (PB) Medical Necessity Medically Unlikely Edits National Correct Coding Initiatives (NCCI) Non-covered Payer specific billing requirements Record requests Apply entry to intermediate knowledge of current reimbursement methodologies and billing requirements consistent with SBO complexity matrix. Work to identify and resolve no response claims including but not limited to claims not received, unbilled claims, and unprocessed claims. Locate missing payments and coordinate with Cash Management to obtain and post payment. Submit corrected claims. Process late charges using the late charge functionality. Generate and release complex itemized statements and medical records. Update claim information including ICN, authorizations, billing information, or other required claim elements. Review and resolve insurance follow-up correspondence. Enter clear and concise documentation in the patient health information system. Identify payer plan issues and work with SBO leadership to identify appropriate next steps including but not limited to system automations, payer contract opportunities, process changes and educational opportunities. Attend applicable meetings including payer meetings and educational opportunities as appropriate. Supports Lean principles of continuous improvement with energy and enthusiasm, functioning as a champion of change. Supports the vision, mission and values of the organi

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